MDSO - Environmental And Metabolic

Question 1

MDSO FEVER:

Tylenol Dose, q, daily Max

Ibuprophen Dose, q , Major Contra

Answer 1

Tylenol : if > 60 kg - - 975-1000mg q 4 hrs; if 40-60 kg — 15 mg/kg q 4 hrs. (PO/PR) - NO PATCH (peads is same dose 15 mg/kg, but max 1 g)

Ibuprophen: > 40 kg - - 400 mg q 6 hrs (PEADS is only above 6 m (below 12) at 10mg/kg - to max 400mg
-contra any bleeding issue (anticoagulation therapy, active bleeding, GI bleed.ulcer, CVA.TBI < 24 hrs)…and if asthmatic any issues with ASA/NSAIDS, Pregnant., Active Vomitting

Question 2

MDSO: Anaphylaxis

Drug, Doses, Patch

Answer 2

EPI IM (1:1000) 0.01 mg/kg IM to max 0.5 mg (max out at 50 kg) x 1 repeat q 5 min - IP
VENTOLIN - 5 mg q 5-15 min x 3 PRN or 8 puffs (800 mcg) x 3 q 5-15 min x 3 PRN
BENADRYL - 1mg/kg/dose - MAX at 50 mg (at 50 kg) IM - No patch
METHYLPREDNISOLONE (aka SOLUMEDROL)- 125mg IV - MP
For persistent Hypotension:
NS 20cc/kg - IP
EPI Infusion - MP - usual dose - 0-0.5 mcg/kg/min

**consider Histamine Antagonist like Ranitidine

Question 3

MDSO: Adult Hypoglycemia

Meds (4 in total)

Answer 3

25g (1 Amp D50W) - IP , then infusion of D10W or D10NS at 100 mL/hr. (250 NS - 50 cc + 1 AMP = D10NS)

If Malnutrition is suspected : Add - Thiamine (Vit B1) = 100 mg IVP

(Thiamine is needed for Oxydative Phosphorylation in the production of ATP via Kreb Cycle, lack of it will decrease Glucose metabolism, and increase Lactate (non O2 metabolism)

Note Glucagon 1 mg IM still an option, rule out pheochromocytoma

Question 4

MDSO: HyperKalemia

What is the normal K+ range ?
What are the ECG Changes Associated with Hyper K
What are the most common causes of HyperK

Answer 4

3.5 - 5.0
ECG - flat P - widening QRS - Peaked T -

Bradycardia - sinus Brad, AV Blocks, BBB/Fascicular Blocks, eventually widening QRS up to SINE
- ECG changes don’t usually present until moderate elevation of > 6

1st - Peaked T @ 5.5-6.5
2nd Flat P, longer PRI @ 6.5-7.0
3rd - Brady various forms - @ 7.0 -9.0
4th - SINE , Asystole, VF, PEA Wide Bizzare @ > 9.0

Causes: decreased Renal Excretions - Kidney
Hormonal : Addisson / Adrenal
Release of Intracellular : Rhabdo, Tumor Lysis, Hemolysis, Beta Blockers, Low Insulin, Dig Tox
Meds: among others, sometimes Heparin
Pseudo - hemolysis during sample retrieval , polycythemia

Question 5

MDSO: HyperKalemia

Drugs/Doses/Conditions/Patch/Considerations

Answer 5

1) NS @ 10 mL/kg - NP
2) Calcium - IP
- 10% Calcium Gluconate - 20mg/kg (max 1 g @ 50 kg) q 5 min PRN, max total 2 doses, more with TMP
OR
- Calcium Chloride - 20mg/kg q 5 min > 20 min PIV, > 5 min CVL - max 1g per dose, max 2 doses **can
Do slow push in pre-arrest)
3) NaHCO3 - IP
- 1 mEq/kg dose *typically give 50 mEq)
4) Dextrose - IP
- 1 amp (25 g of D50W), repeat x 1 if required
5) Humulin R - IP
- 10 units
6) Salbutamol - IP
- 16 puffs x 2 q 5-15 min PRN or 10 mg x 2 q 5-15 min NEB

See flowchart - different treatment based on K mmol

Question 6

MDSO: HyperKalemia : Flowchart

Define Mild, Moderate and Severe Hyper K?

How does this impact treatment ?

Answer 6

Mild : 5-5 to 6.5—-> ECG Normal —> give NS, Dextrose, Humulin, Salbutamol

Moderate: 6.5 - 7.5 —-> peaked T, weakness —-> NS, Consider Calcium, Bicarb if suspect acidosis, then Detrose, Humulin, Salbutamol

Severe: > 7.5 —-> wide QRS, PRI up, Brady +/- Hypotension —-> same pathway as Moderate…except Ca is given not just considered - - - any wide QRS warrants Calcium, but peaked T alone doesn’t

Dig med not necessarily a contraindication , rule out Dig Tox, discuss with TMP